Reconsideration of three screening tests for dysphagia in patients with cerebrovascular disease performed by non-expert examiners

Watanabe, Satoshi; Oh-Shige, Hideo; Oh-Iwa, Ichiro; Miyachi, Hitoshi; Shimozato, Kazuo; Nagao, Toru

doi:10.1007/s10266-019-00431-9

Cited by 8 publications

(6 citation statements)

References 26 publications

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“…Because cervical auscultation is easily performed using a stethoscope, it allows for repeated evaluations of swallowing ability in a noninvasive manner. This is convenient for observing a patient's daily eating status and provides important information for screening and dietary adjustment (Watanabe et al, 2020). However, because swallowing sounds are composed of initial clicks and the sound of bolus transfer and because the final pops are generated in <1 s, they can only be heard as a single sound, and consequently, sensory evaluation is difficult (Leslie et al, 2004; Morinière et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

Real‐time assessment of swallowing sound using an electronic stethoscope and an artificial intelligence system

Suzuki

Shimizu

Ohshimo

et al. 2022

Clinical & Exp Dental Res

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Objectives: Daily assessments of swallowing function and interventions such as rehabilitation and dietary adjustments are necessary to improve dysphagia. Cervical auscultation is convenient for health care providers for assessing swallowing ability.Although this method allows for swallowing sound evaluations, sensory evaluations with this method are difficult. Thus, we aimed to assess swallowing sound by the combined use of an electronic stethoscope and an artificial intelligence (AI) system that incorporates sound recognition.Material and Methods: Herein, 20 fifth-year dentistry student volunteers were included; each participant was drank 10 ml and then 20 ml of water in different positions (sitting and supine). We developed an algorithm for indexing bolus inflow sounds using AI, which compared the swallowing sounds and created a new index. Results:The new index value used for swallowing sound was significantly higher in men than in women and in the sitting position than in the supine position. A software for acoustic analysis confirmed that the swallowing index was significantly higher in men than in women as well as in the sitting position than in the supine position.These results were similar to those obtained using the new index. However, the new index substantially differed between sexes in terms of posture compared with effective sound pressure. Conclusions:We developed a new algorithm for indexing swallowing sounds using a stethoscope and an AI system, which could identify swallowing sounds. For future research and development, evaluations of patients with dysphagia are necessary to determine the efficacy of the new index for bedside screening of swallowing conditions.

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Section: Discussionmentioning

confidence: 99%

Real‐time assessment of swallowing sound using an electronic stethoscope and an artificial intelligence system

Suzuki

Shimizu

Ohshimo

et al. 2022

Clinical & Exp Dental Res

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“…Swallowing function had been assessed in all patients by two speech-language-hearing therapists using dysphagia screening consisting of a repetitive saliva swallowing test [ 19 ], a modified water swallowing test [ 20 ], a food test [ 20 ], and cervical auscultation [ 21 ]. The cervical auscultation findings were compared with “clear” expiration before water was swallowed, and when breathing, sound wetness, stridor, coughing, throat clearing, or voice distortion was judged as “abnormal.” Patients in whom these tests could not exclude the possibility of dysphagia underwent a more detailed swallowing evaluation in the form of FEES and/or VFSS performed by an otolaryngologist.…”

Section: Methodsmentioning

confidence: 99%

Temporal characteristics of aspiration pneumonia in elderly inpatients: From resumption of oral intake to onset

et al. 2022

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Background Elderly inpatients who develop fevers after resumption of oral intake are often considered to have aspiration pneumonia (AP) and be tentatively fasted. Fasting has been associated with prolonged hospital stays and decreased swallowing ability. The purpose of this study was to compare AP and other infections after resumption of oral intake in elderly inpatients and to identify the clinical characteristics. Patients and methods The records of patients who were admitted to a public tertiary hospital and referred for evaluation of swallowing disability were retrospectively reviewed to identify those who had developed AP, non-AP, or urinary tract infection (UTI) after resumption of oral intake. Eligible patients were enrolled consecutively in the study. The patient characteristics, physical findings, laboratory data, oral intake status at the time of onset of symptoms, and rate of discontinuation of oral intake after onset of infection were compared between the three types of infection. Results A total of 193 patients developed an infectious illness after resuming oral intake. Among them, 114 patients had a diagnosis of AP (n = 45), non-AP (n = 24), or UTI (n = 45). There were no significant differences in patient characteristics, physical findings or laboratory data between the group with AP and the other two groups. AP developed at a median of 6 (range 1–16) days after resumption of oral intake. The rate of discontinuation of oral intake was 91.1% in the AP group, 58.3% in the non-AP group, and 26.7% in the UTI group, respectively. Conclusion Infectious diseases other than AP should be considered in the differential diagnosis when nosocomial fever develops in elderly inpatients more than 17 days after resuming oral intake. Furthermore, nosocomial fever after resuming oral intake has many causes other than AP, and discontinuation of oral intake should be carefully considered.

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“…However, when looking at including measures such as CA with the CSE, reliability of both measures can be improved. A study combined CA with a water swallow test to determine the presence of dysphagia (Watanabe et al, 2020), which revealed that even non-swallowing experts were able to accurately detect dysphagia using these methods. Bergström, Svensson and Hartelius et al (2014) carried out an interesting study evaluating the use of CA together with the bedside assessment and then compared their findings with FEES.…”

Section: The Assessment Measuresmentioning

confidence: 99%

Decision making and the bedside assessment: The Speech Language Therapists’ thinking when making a diagnosis at the bed

Coutts

Pillay

2021

South African Journal of Communication Disorders

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Background: The bedside assessment is often seen as a screener because of its high variability in sensitivity and specificity, whilst the instrumental measures are viewed as gold standards because of the ability of speech-language therapist (SLT) to visualise the swallow more objectively.Objectives: This research article explores how the value needs to be placed on the decision-making abilities of the SLT rather than on the assessment measure itself.Method: A mixed methodology concurrent triangulation design was employed to collect data in two phases: the first phase included observing seven SLTs conducting assessments using a standardised bedside measure together with pulse oximetry and cervical auscultation. The second phase was a focus group discussion based on the findings from the first phase. Data were analysed thematically using a bottom-up approach.Results: The following factors were found to influence the decision-making process at the bedside: bedside assessment data sets, patient, multidisciplinary team, context and then SLT. The availability of more data from the assessment from different data sets improved the confidence of the SLT at the bedside when needing to make clinical decisions. Clinical instincts are developed through experience and observation of those more experienced. These skills need to be developed from junior years.Conclusion: This research study showed that a bedside assessment can provide valuable information that will allow for diagnostic decisions to be made at the bedside. This study also highlighted the importance of critical thinking using clinical instincts, and that these are the factors that need to be valued and emphasised rather than the assessment measures themselves.

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Reconsideration of three screening tests for dysphagia in patients with cerebrovascular disease performed by non-expert examiners

Cited by 8 publications

References 26 publications

Real‐time assessment of swallowing sound using an electronic stethoscope and an artificial intelligence system

Real‐time assessment of swallowing sound using an electronic stethoscope and an artificial intelligence system

Temporal characteristics of aspiration pneumonia in elderly inpatients: From resumption of oral intake to onset

Decision making and the bedside assessment: The Speech Language Therapists’ thinking when making a diagnosis at the bed

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